A9901, Dme delivery, set up, and/or dispensing service component of another hcpcs code
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Documentation supporting medical necessity for the dehumidifier (clinical rationale and need).
- Documentation of member residency in Arkansas when applying the § 23-79-1502 statutory mandate.
- Verify and document member's group type (to determine applicability of ASO exclusion).
- Refer to the appropriate item-level Medical Policy for any additional item-specific documentation requirements.
Key Coverage Criteria
- Coverage of a dehumidifier every four years when medically necessary for HCSC members residing in Arkansas per § 23-79-1502 (relating to craniofacial anomaly corrective surgery).
- Coverage of specific durable medical equipment items as specified in the appropriate item-level Medical Policy and member contract benefits.
- Equipment serves a medical purpose.
- Equipment is not generally useful in the absence of illness, injury, or disease.
- Equipment is intended for use in the individual’s home/place of residence.
- Equipment is reasonable and medically necessary for the individual.
5 Active Policies
DME101.000, DME Introduction
BCBSIL-DME101.000, Durable Medical Equipment (DME) Reference List
BCBSMT-DME101.000, Durable Medical Equipment (DME) Reference List
BCBSNM-DME101.000, Durable Medical Equipment (DME) Reference List
BCBSOK-DME101.000, Durable Medical Equipment (DME) Reference List
Related Codes
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